Systematic desensitization (DS) is a technique developed by Joseph Wolpe in 1958, which proposes to terminate both the anxiety responses and retreat behaviors expected of anxiety upheavals.
The principle is that the intensity of a response such as anxiety can be reduced by emitting an incompatible response, such as relaxation. The appearance of some phobic stimuli produces anxious responses.
Some stimuli automatically produce anxious responses. together, it aims to provoke an automatic relaxation response that interferes with the discomfort of the aversive stimulus.
What Is Systematic Desensitization?
Table of Contents
Systematic desensitization is a technique used in psychotherapy for cognitive-behavioral orientation for the treatment of phobias, in order to reduce levels of anxiety related to a phobic stimulus. This progressive desensitization technique is based on the fundamental principle that an individual cannot experience anxiety and relaxation at the same time.
Starting from this assumption, the therapist presents the patient with stimuli capable of causing anxiety, with increasing intensity, while the patient is in a state of deep relaxation, the relaxation will eventually prevail over the anxious response and replace it, thanks to emotional desensitization. related to that specific stimulus.
This technique, still widely used in psychotherapy today, was developed in the 1950s by Joseph Wolpe, starting from the theories on operant conditioning. Some of the most common phobias such as the fear of flying, public speaking, or a certain animal are now successfully treated with this technique.
How Does Systematic Desensitization Work?
The standardized systematic desensitization procedure includes four steps. Training in relaxation, construction of hierarchies, evaluation, and practice in the imagination and the same systematic desensitization. Before dedicating yourself to training in relaxation, it is necessary to explain the technique to the client, motivate him and make him understand the basic strategy and the principles of technical efficiency.
You have to explain what incompatible responses are and why if one appears, the other cannot appear (such as relaxation and tension), what a hierarchy of stimuli is, and what is counterconditioning and generalization in understandable terms.
The relaxation response that the patient will use to combat anxiety will preferably be the one that he or she already knows. Any procedure can be used, but if possible it is best to use a type of relaxation that the patient can put into practice quickly and effectively.
Otherwise, techniques such as progressive relaxation or breathing control, which are simple techniques to learn, can be taught. The key thing is that in an anxious situation, these incompatible relaxation responses can be applied easily, quickly, and effectively to reduce anxiety.
This is what we call an anxiety hierarchy, in which we list all potentially anxious situations related to the topic to be discussed and order them according to the degree of anxiety they generate. To quantify the anxiety generated, a scale from 0 to 100 is used, where the situation with a score of 0 does not generate anxiety at all, and the condition with a score of 100 is the one that causes the most anxiety.
To develop the hierarchy we do it through brainstorming in which the patient generates situations that cause anxiety. These situations are recorded, specified, and given a number on a scale of 0 to 100. A good way to get started is to use anchors. Generate the least and most anxious items first, which will be 0 and 100 respectively, and an intermediate item which will be 50.
Practice in the imagination
Since we will use the exhibition in the imagination, we must evaluate the patient’s ability to imagine the scenes. The patient will be asked to imagine a scene and then ask for details to see how vivid the visualization is in the imagination.
Once insured, the situation causing anxiety will be presented. This presentation can be in the imagination or live. It will start with the situation that causes zero anxiety and gradually move up the anxiety hierarchy. The first presentations are made briefly, but the exposure time will increase more and more.
Of course, the longer the patient is exposed, the greater the desensitization. Furthermore, when it is possible to reduce the anxiety produced by a situation, it is generalized to situations that are above it. Articles are considered obsolete when they produce zero anxiety – that is until one situation generates absolutely no anxiety, you can’t move on to the next.
Systematic desensitization applications
Systematic desensitization is an appropriate treatment when the therapist directs his efforts towards the elimination of phobias and anxieties whenever a number of conditions are met. In order for a conditioned response to be susceptible to change through systematic desensitization, it must be a response to a specific situation or stimulus, not due to irrational beliefs or overrated ideas, that is an irrational fear, and that there is an adequate response incompatible with anxiety.
In addition to its use in phobias and anxiety disorders, it can also be adequate for treating anxiety by specific stimuli without being phobic. For example sexual dysfunction, alcoholism, other addictions, paraphilias, or insomnia.
Systematic Desensitization: Is It Useful For Treating Phobias?
Scientific research in the field of systematic desensitization has shown how this technique is very effective in the treatment of specific phobias, social phobia, and the reduction of anxious states. Recent studies have confirmed the effectiveness of the technique also in the treatment of patients suffering from depression or schizophrenia.
Systematic desensitization is currently regarded as the most effective technique used in psychotherapy for the treatment of animal phobias. Through the gradual exposure to the stimulus or to the fearful situation, first imagined and subsequently in vivo, the subject will become able to control his emotional response and therefore his phobia, up to the exhaustion of symptoms. In the case of subjects suffering from multiple phobias, the systematic desensitization technique is applied alternately to each phobia in the same way.
What Are The Stages?
Systematic desensitization consists of three stages :
First phase: the patient during the first phase of treatment is trained in the use of relaxation techniques, such as progressive muscle relaxation and diaphragmatic breathing. The purpose of these techniques is to train the patient to use relaxation to reduce physical sensations related to anxiety (such as tremors, tachycardia, hyperventilation, etc.) and thus be able to control their phobic reaction in front of the object or feared situation.
Second phase: the second step consists in investigating the phobic stimulus. The patient guided by the therapist will create a hierarchy of disturbing situations, starting from the least anxious situation to arriving at the most feared one. In order to work gradually to extinguish the phobic response.
Third phase: in therapy, the patient guided by the therapist will begin to face, first on an imaginary or virtual level up to the in vivo exposure, the feared situations starting from the lowest rung of the hierarchical ladder that he himself has created.
The goal of this technique is to teach the patient an alternative way of responding to a specific phobic stimulus through the use of the relaxation techniques learned. Through the progressive exposure to the stimulus and the consequent controlled response, the subject reaches full control of the situation until the symptoms disappear, a situation in which relaxation replaces the anxious response.
Which kind of therapy involves a therapeutic orientation that uses principles of learning theory to help clients change undesirable behaviors Quizlet?
Clarification-oriented psychotherapy (KOP) is, as all results show, a very effective form of psychotherapy that opens up many flexible options for therapists and enables therapists to use client processes in a very constructive manner control (Sachse, 1992, 2003; Sachse, Fasbender, Breil & Püschel, 2009; Sachse & Sachse, 2009).
Clarification-oriented psychotherapy is also, as all therapists who have learned it and all the supervisors who supervise it say, a very complex form of therapy that requires a very high level of expertise from therapists: Therapists must have broad psychological background knowledge, must be able To process information quickly and effectively and must implement targeted interventions that constructively promote clarification and processing processes for clients (Sachse, 2006a, 2009).
Therapists have to follow therapeutic rules; However, you do not have to follow these rules in a “manual” manner, but in turn, have to implement the rules correctly in an expert manner. Rules must enable therapists to do the right thing at the right time.
Rules thus represent an important “knowledge base” that therapists must have at their disposal quickly and reliably and which they must use flexibly and appropriately for the situation. Therefore it is not enough to know the rules; one must rather be trained in their application (Becker & Sachse, 1998).
Before you can be trained, of course, you first have to know and understand the rules; This is what this text is about: It describes the most relevant rules for therapists who want to apply clarification-oriented psychotherapy.
The rules presented here are derived on the one hand from the empirical results on KOP, on the other hand also from our therapy, supervision, and training experience. From our point of view, they, therefore, represent a valuable heuristic for therapeutic work.
2. Specific strategies in different therapy
phases If the relevant schemes have been adequately reconstructed, then it is a matter of processing the schemes: The dysfunctional schemes must be questioned, “attacked”, inhibited and through functional alternative schemes are replaced.
Phase 3 is special in that it has to be defined individually for each client, specific to the disorder, which rules and strategies should be followed. Fault-specific rules and strategies of the KOP can be found, for example, in Sachse (2001, 2002) and Sachse (2004, 2006b).
With regard to phases 1, 2, and 4, however, general therapeutic rules can be derived that are valid for almost every clarification-oriented therapy. Therefore, the specific rules for these phases will be discussed in more detail below.
3. Rules for building relationships
The most fundamental aspect of psychotherapy is the design of the therapeutic relationship by the therapist (cf. Sachse, 2006c): Relationship design is the first thing a therapist does and the therapist has to do it consistently, i.e. throughout the entire course of therapy.
Relationship creation serves to establish a trusting therapist-client relationship: Without such a relationship, the “rest” of the therapy will not work either.
3.1 Actively create a therapeutic relationship with the client so that the client can develop trust in the therapist and trust in himself!
Relationship formation is central in therapy: a therapist must actively, plan, deliberately, and purposefully create a relationship with the client so that the client trusts the person and the therapist’s competence; only then is the prerequisite for constructive therapeutic work created. The therapist should also give the client confidence in himself because this is what the client needs in order to be able to “face” unpleasant problems content.
Relationship design thus has many different aspects, the most important of which are listed here.
3.2 Never do anything that could harm the client!
This is the most fundamental principle of therapeutic work: a therapist should never do anything in the therapy process that could harm the client!
At first glance, this sounds trivial; however, there are situations in which this principle is very important. An example is a situation where a therapist decides that he cannot work with a particular client. He can come to the conclusion that it could affect the client if he tells the client that he does not like him or the like, even if he makes it clear that this is only “his problem”; the client can take it as a devaluation in any case. In this case “authenticity” is by no means the highest therapeutic good, but the principle of not harming the client.
Therefore the therapist finds a different justification for the client: e.g. that he is not an expert on the client’s problems and therefore recommends another therapist to the client. This in no way means that a therapist should be dishonest with the client: however, if honesty would harm, then it is inappropriate. It is more important not to do anything that could harm the client.
3.3 Give the client different and more constructive experiences than in everyday life!
Therapy cannot be the continuation of everyday life with other means: then therapy would be just as effective as everyday life, namely not at all! The client should have different and more constructive experiences with regard to the therapeutic relationship as well as the therapeutic treatment than in everyday life. For this reason, therapy must also be well-thought-out, goal-oriented, tailored to the client, and supported by the therapist’s expertise!
Client comes into therapy because their normal support system in everyday life is no longer sufficient to cope with their problems. It is obviously not enough to discuss the problem with friends and acquaintances, the “normal” social feedback and confirmations are obviously not enough. The client therefore obviously needs an offer in therapy that goes beyond everyday communication. What the client needs in each individual case can only be determined through specific diagnostics.
In principle, however, it is necessary that the therapeutic offer goes beyond everyday life in two areas:
– in the design of the relationship,
– in the design of the interventions.
Regarding the interventions, therapists must specifically promote relevant client processes, but also specifically block dysfunctional processes, something that is impossible in everyday communication. This also implies the realization of forms of interaction that one should hardly allow oneself in everyday life: interrupting the client, drawing his attention to the fact that he is not answering a question, confronting him with contradictions, etc. The realization of meaningful interventions sometimes requires that the therapist deliberately violates social conventions of interaction.
At the level of relationship building, the therapist can create the basic prerequisites for a self-opening of the client by realizing acceptance, congruence, and empathic understanding, which goes far beyond the degree of openness that the client can achieve in everyday life with friends or partners.
The postulate also implies that a therapist should not behave in a complementary manner on the behavioral level, as this usually means that he cannot have any other experiences than in everyday life: This means, for example, that the therapist is not simply “in solidarity” with the client, too then not when the client expects it, but rather that the therapist is able to question the client’s assumptions, even if this is uncomfortable for the client.
An essential implication of this principle is that a therapist cannot be “polite” as in everyday situations: Therapists confront clients with embarrassing content, ask the same question three times, etc. That is, they do many things that interaction partners would never do in everyday life (and never should!).
Therapists are also loyal to clients: that is, they support their clients, sustain them, build them up, etc .; however, they do not show solidarity with their clients against third parties; they cannot be “built into” the client’s social network as “normal” interaction partners.
3.4 In the first phase of therapy, create a therapeutic relationship according to the rules of general relationship design!
Realize empathy, acceptance, warmth, loyalty, authenticity, and transparency in the therapy process as much as possible.
The basic therapeutic variables form the foundation of clarification-oriented therapy. A therapist should always approach the client in an accepting and empathic manner in order to always “maintain” the therapeutic relationship. This also helps the therapist to maintain a client-centered attitude, which is central to clarification.
3.5 Treat the client like a valued customer!
The client is a customer who visits the therapist because he needs support in clarifying and coping with his problems. A client is a person who should be respected: respect as a person and respect as a customer.
Under no circumstances should a therapist afford to treat clients as “not sane”, “incapable”, “weak”, “immature”, “naive”, or the like: because the client will be withdrawn and defended against it react and the therapist will never be able to realize the necessary basic variables with such an attitude! Thus, a sustainable therapeutic alliance can never come about.
Systematic Desensitization Or Exposure?
Sometimes considered synonyms, others erroneously distinguished, systematic desensitization and exposure are very valuable techniques in the psychological field in order to treat problems associated with anxiety.
Systematic desensitization and exposure are techniques often used in psychology. Generally, they are considered useful for putting the subject in contact with the stimulus that terrifies him or that causes anxiety in him, in order to reduce it.
In light of this, these techniques may be particularly useful for treating anxiety disorders (they are very effective in cases of phobia), mood disorders, or obsessive-compulsive disorders.
Since anxiety is a constant in any mental disorder, we are talking about two truly versatile techniques. However, the limits presented by one can be overcome by the other (such as the problem of abandonment or denial in the event of exposure with response prevention).
Thus, systematic desensitization and exposure are believed to be great techniques for eliminating fear through fear itself.
What Is Systematic Desensitization? What Is The Exhibition?
Systematic desensitization (DS) and exposure aim to eliminate the subject’s fear of a stimulus. Whether it is public speaking, snakes, or anxious expectations about the future, the aim is that this stimulus no longer poses a danger to the patient.
Exposure – or exposure with response prevention (ERP) – is aimed at preventing the subject from avoiding or running away from the phobic or anxiogenic stimulus, and this makes the behaviors that act as reassuring behaviors vanish. In this way, these will stop being a support for the anxiety produced by the stimulus, favoring its disappearance.
What Are Some Examples Of Systematic Desensitization?
The process of systematic desensitization is different for each person.
Some people move through low levels quickly and have difficulty overcoming higher levels. Others may take a long time to work through lower levels, but they find the fear easier to face once they have been successful at the lower levels.
The most useful relaxation technique can also vary. You can find visualization helps you relax as much as possible, for example.
Regardless of your fears or how much time you spend working through each level, the same principles remain.
Here’s how systematic desensitization can look for different conditions.
You are a college student with social anxiety. When you think of giving the wrong answer in class or having to ask to use the restroom, you feel sick and your heart is racing. You avoid talking in class or attending college activities to avoid embarrassing situations.
When you decide to try systematic desensitization, you decide that talking to someone you do not know is a level 1 fear.
Then you need to start working on the next fear – make eye contact during the conversation. You work your way through the hierarchy, eventually introducing yourself and nodding together in class.
The final level of your fear hierarchy involves division into class. It takes a few tries, but in the end, you are able to answer questions in class, even if your heart is still starting to race when you put your hand up. You take a deep breath, release tension in your muscles, and start talking.
When you see a dog coming towards you in the distance, your palms are sweating, your heart is running and you are having trouble breathing. Your phobia specifically relates to being bitten, but being around dogs also makes you feel scared and nervous.
To get started on your hierarchy of fears, you start by imagining you are near a dog on a leash in a passing car. The next day you drive with a dog park several times. It does not seem to affect you much so you park in a place where you have a full view of the park.
You feel tense up every time a dog starts barking. To combat this, you concentrate on reclining your muscles and imagining yourself on a wonderful beach – one out of dogs. You start your foci and repeat this process for the next 30 minutes.
How Can I Try It On My Own?
It is possible to try systematic desensitization on your own, but remember that slow, gradual exposure is a key element of this strategy. If low exposure makes you feel anxious, keep practicing your relaxation techniques and working on this fear.
There is no real pace to working through your hierarchy of fears. You can spend months on a single, just to burst through the next two over the course of a few weeks.
Take as much time as you need. If you move too fast, you can put yourself through unnecessary discomfort.
If you would like to try this method on your own, the following tips may help:
Familiarize yourself with relaxation techniques. If you are already feeling tense and anxious, thinking about relaxing can be harder, so it is important to learn these techniques first.
Practice exposing yourself to your fears every day. Even a few minutes every day can help.
Remember to stop and use a relaxation exercise when you are feeling anxious. You may have to try each step several times and that’s OK.
Try to continue the exercise until you feel about half of the fear or anxiety you typically would. This can be difficult to measure, but you will probably be better able to track it as you become more familiar with exposure.
If you are in doubt about attempting systematic desensitization on your own, a therapist can answer any questions you have and offer support. If the approach does not work well for you, you can explore other methods of therapy.
For Which Disorders Is Systematic Desensitization Indicated?
Despite the documented effectiveness, systematic desensitization does not serve to treat all psychological problems that exist. In some cases, it seems to be not very helpful, while with some suffering it can turn into contrast.
In general, systematic desensitization works perfectly with most types of specific phobias. When one of these diseases occurs, it is usually only a few sessions that are needed to eliminate it completely and that it no longer presents a problem to the patient.
In addition to specific phobias, systematic desensitization can also help treat more complex problems such as phobia or social anxiety, and some other anxiety disorders such as post-traumatic stress disorder or obsessive-compulsive disorder. But in these cases, it will usually be necessary to accompany it with other techniques.
Finally, other mental illnesses, such as those belonging to mood disorders or schizophrenia, cannot be treated using this method. In fact, some studies seem to suggest that systematic desensitization may exacerbate the problem in these cases.
There Are Three Phases To The Treatment
Systematic desensitization is a type of behavioral therapy based on the system of classic conditioning. It was developed by Wolpe in the 1950s. This therapy aims to eliminate the fear response from a phobia and replace the conditioned stimulus with a relaxation response using counter-conditioning.
Teaching the relaxation technique
First, the patient is taught a deep muscle relaxation technique and breathing exercises. These techniques can be breathing exercises, muscle relaxation, or meditation.
This step is very important due to mutual inhibition, where the reaction is once inhibited because it is incompatible with another. In the case of phobias, fear involves tension, and tension is incompatible with relaxation.
Create a fear hierarchy
Second, the patient creates a hierarchy of fears that begins with the stimuli that create the least anxiety (fear) and gradually builds up to the images that cause the most fear. The list is crucial as it provides a structure for therapy.
Climb the hierarchy of fear
Third, the patient moves up the fear hierarchy, starting with the least unpleasant stimuli and practicing his relaxation technique as he progresses. Once they are familiar with this (they are no longer scared) they move on to the next step in the hierarchy. If the patient has a bad time, he can return to an earlier stage and regain his relaxed state.